Transcript auto-generated 

Brianna Battles  00:01

Welcome to the Practice Brave podcast. I am the host Brianna Battles, founder of Pregnancy and Postpartum Athleticism, and CEO of Everyday Battles. I’m a career strength and conditioning coach, entrepreneur, mom of two wild little boys and a lifelong athlete. I believe that athleticism does not end when motherhood begins, and this podcast is dedicated to coaching you by providing meaningful conversations, insights and interview topics related to fitness, mindset, parenting and of course, all the nuances of pregnancy and postpartum, from expert interviews to engaging conversations and reflections. This podcast is your trustworthy, relatable resource for learning how to practice brave through every season in your life.

Brianna Battles  00:51

Mindy English  01:58

Yeah, thanks for having me. It’s hard to believe we’re almost to the end of the year of doing that. I

Brianna Battles  02:02

know and like this episode, we pulled the audience both in stories and as well as a reel on social media where we just said, like, what questions do you want to know? And what’s going to be interesting about this episode is it truly spans, like, from very clinical questions to performance based questions, and then just, I guess more, I guess generic questions that people have. Because again, a lot of this is not intuitive. It is not straightforward, and social media can be really confusing. A lot of pelvic floor PTS are not practicing in the way that you do. And like the industry as a whole, there’s work to do, and that’s not to say that good work isn’t being done, that research isn’t moving forward. It all is. It’s just not you know what we’re what we are seeing in real life, what we have been seeing for the last decade with the women that we are working with from a coaching perspective as well as a clinical perspective. So just trying to be a little bit more transparent, have conversations that make this stuff just like more applicable and relatable. So on that note, we’re going to dig into it, because we have a decent amount of questions here that have come up. And I’m going to be the question asker, and then I will chime in when it comes into like, my scope a little bit more, and we’ll just tag team it a little bit. All right. First question, this is no particular order, by the way. I would love to like for it to like for it to storytell and make sense, but we’re just going to go like random rapid fire. All right, this person is pregnant again at six months postpartum, so babies back to back and before her core has fully reconnected, at least in terms of how she feels. Do you have tips for core and pelvic floor support with two pregnancies so close together?

Mindy English  03:41

Yeah, yeah. That’s a great question. And I think whether you’re six months postpartum or, I think there’s a lot of women who could feel the same way two years postpartum that they don’t feel like their core is back to where they want to be or feel connected there. And so I think the answer is, it’s still, it’s, you know, finding, understanding that core and pelvic floor connection is important no matter where you are postpartum and whether you’re pregnant or not or again, there’s been a lot of great research over the past really couple years that’s looking more at core exercises during pregnancy, and what we used to think was not a great thing, we’re now realizing, like we can actually probably do a little bit more. It doesn’t mean I have to stop doing all core exercises. And core exercise we always think of traditional sit ups. And it doesn’t just have to be sit ups. There’s so many ways to train your core functionally and feel really connected and strong, even if you aren’t feeling connected, and it’s really quick in between your pregnancies. So I think working with someone, if it’s if that’s doable, work with someone who can help you find your core, understand where your core is, and kind of meet you where you’re at, so that you can progress confidently through your pregnancy. Because that’s the most important thing, is that you feel really confident and and are feeling strong in your body as you go. Through again, regardless of how close together those pregnancies are

Brianna Battles  05:03

totally and like, there’s so many things with with your training alone, where you it’s not even just like the core specific training, it’s more of like the core involved and like timing your breath, and if you’re able to, you know, do one of our favorite cues that, like zip your clit, like that little bit can provide more attention to that midline tissue as it is stretching over time. And I think that’s like you had said, there’s plenty of people who still have a very significant diastasis that then get pregnant again and again and again. So just that awareness in general, I feel does so much for women. All right, next question, is it very obvious when you feel what you feel for with the pelvic floor, when you’re examining for strength?

Mindy English  05:48

Yeah, I love this question. The in general, yes, in the sense of, if I’m looking for strength and I’m assessing internally, I’m assessing, can someone squeeze around my finger, and can they relax around the finger? Now, the nuance to that is it’s not always that easy for someone to produce that contraction. And so yes, what I’m looking for is easy for someone to be able to do that, and for me to be able to tell if they can’t do that, like the why is that because they’re weak? Is it because they’re too tight and they’re actually not like relaxing, so they’re just trying to tighten on something that’s already too tight, or do they just not understand what those muscles are? That’s where it gets a little bit more complicated or challenging, on my end, is like putting that piece together. But as far as like, can I feel someone squeeze and relax. That part is pretty easy. If someone knows where those muscles

Brianna Battles  06:45

are, I’m going to ask like a follow up question that is not asked. So then, would you recommend somebody themselves being able to do like a self assessment and feel that like around their own finger? Or is that like too complicated to try to troubleshoot? Yeah.

Mindy English  07:02

I mean, I think if people who are comfortable with that, you could, you could do a self assessment. Or a lot of times I have people use a mirror, so you can visualize with a mirror, like, can I even see movement there? Sometimes that’s helpful for people is, can I, like, see it contract and relax of the muscles?

Brianna Battles  07:22

Yeah? I think some people think like, oh, it’s like, so inside, but you can see from the outside when, like, looking up into your vagina, basically, what happens, like, the whole go up and then relax down, right to be like, super

Mindy English  07:35

forward, yeah. And so just the visualization isn’t necessarily testing strength, but it’s a testing like, can they contract and can they relax? So, yeah, like a finger, some people will use, like a dilator to see if they can contract and relax around it. All those things just give tactile feedback for someone. I mean, without training, it’s hard to the amount of strength is such a it’s an objective slash subjective measure, like someone who didn’t know what they were looking for would be able to say, like, Yes, I can squeeze and I can relax. You wouldn’t necessarily be able to without the train, say, like, Oh, that’s a really strong contract,

Brianna Battles  08:11

right? It’s more of like that, like that self, like that neuromuscular feedback, okay, this is a contraction. This is a this is me, like, relaxing. Okay, I can relax a little bit more or whatever.

Mindy English  08:21

Yeah, yeah, absolutely. That’s

Brianna Battles  08:23

interesting. All right, how do you know when you are bracing correctly?

Mindy English  08:29

So there’s a couple different variations of bracing, and that should depend on what you’re doing, the activity that you’re doing. So I think the easy answer is, like, does it feel like, Does it feel good and supportive when you’re doing a lift and after? So whether that’s pelvic floor symptoms, like, do you have pelvic floor symptoms after you’re doing something like, if you’re bracing really hard for lifting something really light, and then you have pelvic floor symptoms, or you have back symptoms, or hip or whatever symptoms in that area, then that might not either there’s something wrong with your brace or your technique. So yeah, it’s, I feel like it’s like one of those. It’s like, kind of a complicated, not complicated. There’s just like nuances to it, to know, like, yeah,

Brianna Battles  09:17

or one right way. It’s just like very individual. And I think that, you know, we’ve been taught in, at least in the strength, conditioning and performance Olympic lifting realm to essentially Valsalva, like out, you know, rip thrust up out into the midline, or kind of bearing down into the pelvic floor. And that’s only two variations of other ways to brace. And when working with female athletes, if, especially if they have core and pelvic floor considerations, pregnancy, still recovering, phase, postpartum, managing different core and pelvic health symptoms like that cue breathe into your lats is pretty universally like well tolerated most people I work with, whether they have symptoms or not. Most. Women anyway, really see a benefit from distributing that pressure higher and wider. You’re still getting a brace. You can manipulate your breath timing with that. And I feel it just it just helps provide another way. It’s not the way. It’s just another way that has not been traditionally cued or suggested, especially for women who have different anatomy than what Valsalva was kind of created for initially.

Mindy English  10:27

Yeah. And so I think you you have to be willing to play around with some different strategies. CEO safely. Again, this is where it’s helpful to have a coach who can help you see from the outside and give some different cues for you, because it is it’s just going to be really different for everyone, it’s going to depend on, like, the flexibility of your thoracic spine and your rib cage, and your ability to even expand into the backside, into your lats. So there’s lots of things that go into a good brace. And so I think, yeah, the important thing is that there’s not just one right way to do it.

Brianna Battles  11:04

Great answer. We’re going to move into a clinical question now, so I don’t expect everyone to track I just was like Mindy. I’m making sure I don’t have any typos in here that this is all good, because this is not my language either, but this is going to be really good. All right, do you always assess gh plus pB. And how much does it weigh into your assessment if someone has pop and a larger hiatus and still wants to continue CrossFit, for example, what would your suggestion be for them?

Mindy English  11:34

Yeah, so gh plus pB is a clinical term. It’s part of it’s a measurement basically of what’s called basically the space between, okay, so GH is genital hiatus, Pb is perineal body. So it’s measuring basically the space between, like, the mid portion of the urethra and the mid portion of the anus, and seeing like how much space there is between Yeah, essentially, right. And so it can be predictive of progression of prolapse. It can be predictive of how well someone’s going to respond to a pessary, potentially, like, if someone’s at risk of like, if they have surgery that that might fail and they could develop some symptoms again. And so I think as far as, like, the question of, do I always use it? This is where I’m going to be really transparent. I think I’m starting to understand more how we could use it. And I think there’s a lot of pelvic floor clinicians who might feel the same way. It’s not something that is always taught in, like, an entry level pelvic floor is not taught an entry level pelvic floor class. It’s kind of brushed over in some of the prolapse classes. It’s not really till you get to more advanced training in those conditions and so, so I’ll be transparent. It’s something I’m starting to use a little bit more and think about more like all things. So the gh plus pB is a part of a bigger test called the pop Q, which is really developed to kind of quantify prolapse with all things. It’s part of the clinical picture. All of that is done in supine, which is fine and great. There is great clinical utility to it. We still have to understand what someone’s doing when they’re standing up, and if we’re talking about CrossFit, we have to understand how they’re bracing, how they’re moving the weight. So I can’t hang my hat on there’s like a number. If someone has this number, I would tell them to do X, Y, Z, from a modification or a do or don’t do CrossFit. It is part of a larger conversation. It’s like all things. It’s part of having conversation with people of this is what I see. These are potential risks. There’s always risks, right? Like people always say, Is this going to make my prolapse works? I can’t. I can give you a general like, thought based on what I see and help you, like, make an informed choice based on risk. But I don’t have a crystal ball. I can’t say, like, you’re going to go do a power clean at your max rep, and it’s going to be fine. Like, I don’t know. I We are a human body, and again, there’s always risk with things. So I think it helps us make informed decisions. It helps guide some decision making of, Am I recommending someone to go get a pessary and is that going to be potentially successful for them, to allow them to keep doing the exercises that they want to do? Yeah, I

Brianna Battles  14:43

agree, and I really like what you said about like these tests, these clinical tests, are done in supine and when you’re working with an athlete like you have to under, they have to understand like that, almost like proprioception, of like, what is happening when I am, like, catching a bar. Barbell when I’m squatting, when I’m coming out of the bottom of a squat, when I’m pulling the barbell from the floor, when I’m doing a box jump, when I’m running, and being able to, like, almost simulate that pelvic floor reaction and have that kind of real ish time feedback in that controlled setting with a PT that is in terms of like, it transferring to CrossFit is like, at least gathering some feedback there. And it’s not going to be like the same exact test, but I think adding that to a repertoire of like, prolapse and pelvic health, I’m hoping, can be standard of care, especially when working with female athletes who are not on their back, like, very rarely are they like on their back, doing a lot of these movement patterns, but being able to, like, have that automaticity and that control and that awareness that’s going to be, I think, a key player for adding that to the assessment, adding that to part of that conversation. And I like that you mentioned that next question, how do I stop peeing when I do double unders, and how do I find a pelvic floor? PT, like you in different areas.

Mindy English  16:07

I love this question. I say that about all the questions. I love all of these. I was really excited about this episode. Yeah, okay, so peeing during double unders first there’s a couple really quick things you can try to help with that. So biggest cue this is I learned from you, tits over toes is super helpful for a lot of people. A lot of people are really like arched back, rung up in the rib cage, while they’re doing double under. So just that idea of tits over toes can make a big difference from a position standpoint. Also making sure you’re not holding your breath the whole time you do double unders, you don’t have to time your breath with every double under you just have to breathe that pressure off. So those would be my two quick like, give it a try, tips. The other thing that I find a lot, because I have lots of women who’ve come to me they’ve done the pelvic floor PT and double unders are the thing that they still leak with. Oftentimes, there is a weakness in their glutes that needs to get improved. And I’ve had plenty of people who have quote, unquote strong pelvic floors, like, right? If we test their strength, they’re pretty good, and then they still pee when they double under. So we give them a few cues. We strengthen up the glutes. We make sure they’re absorbing force well through their ankle so they have good ankle mobility, and it generally clears itself up for most people. Yep, I agree.

Brianna Battles  17:32

I think a lot of people are like, I just have to get a stronger pelvic floor, strong, strong, strong, but then that just creates a lot of tension and glute gripping and stuff like that, and stuff like that, and it doesn’t allow the pelvic floor to actually respond to that consistent, repetitive force absorption and production that we see in double unders and running.

Brianna Battles  17:49

Yeah, all right. How do

Brianna Battles  17:51

people find you, someone like you,

Mindy English  17:53

someone like me? So, um, you can always send me a DM, and I will ask my network for where you are, but you can search the if you go to the PMPA website, there’s a list of practitioners who will list if they’re physical therapists or not. And again, if you just reach out and ask, I can ask my network of who do you know in these places that practices in a more fitness forward

Brianna Battles  18:24

way, exactly, and if a pelvic floor physical therapist has taken this certification, they are practicing with a very fitness forward approach to their clinical practice. So that’s that kind of helps narrows, like the specificity of like this particular conversation, all right, does the pelvic floor muscles experience DOMs like other muscles do and DOMs means delayed onset muscle soreness. So basically, can it get fatigued and tired and sore? Sure.

Mindy English  18:56

I mean their muscles, just like any other muscles. So can they Yes, I think when I read this question again, I’m a why person, right? So I always go to a bigger global perspective of why. Like, why are you feeling soreness in your pelvic floor? And what was that after? Okay, like, are you freshly postpartum? You did 1000 kegels. Like, yeah, that might feel kind of sore. Are you sore in your pelvic floor because you did squats and you were, like, actively contracting your pelvic floor while you did the squat? That’s a very different conversations. And I have different questions about, like, the why, why you feel like you need to contract your pelvic floor while you do the squat? It’s not that I have never cued that. I do cue that sometimes, for some people, but again, it’s, it’s a why we want the pelvic floor to be responsive to an activity, and they’re large. Like in a more complex movement, going to serve as a support muscle, not like the main mover of of whatever movement you’re doing. So again, lots of questions of when you’re feeling sore, what exercise you’re doing, to help understand the why and if that’s an appropriate sore to be having. And

Brianna Battles  20:19

we got a follow up question to this, which I think will play think will play well. Different person, though. So this person is 12 weeks postpartum. She wants to start running again. How to determine if she’s healed enough to do so when she’s done lighter cardio activities, her pelvic floor always feels sore after,

Mindy English  20:38

yeah, so I think that goes back to again. What are the other muscles around the pelvic floor doing? So when we think of the pelvic floor, it serves a support function and a stability function between our hips and our low back and our pelvis when we walk and move around, it is part of a system. Again, it shouldn’t be the main worker when you’re running. And so if you have soreness in your pelvic floor after you’re running, I think it’s a sign that there’s something more globally happening with how the muscles of your core and your glutes, your low back, you know, like all the muscles in that system, how they’re all working together, that is causing that soreness, and especially early postpartum, I would imagine there are, there’s still imbalances that are probably there. And so it’d be worth doing some return to run screening kinds of things to tease out where the problem is that might be causing your pelvic floor to still feel sore after you run.

Brianna Battles  21:44

Yeah, and to be like, really, really direct, like, I find a lot of especially postpartum, well and pregnant athletes who feel like soreness or like achiness in their pelvic floor oftentimes are very grippy. They’re sucking in their stomach all the time. Or they’re gripping their glutes for more, for that feeling of support. Same with their abs, like they’re sucking in their stomach, maybe because you feel like weird and fat and soft and squishy, and so you’re like, sucking in to try to try to create tension in the core. But same for the pelvic floor, if you feel like, ooh, like, I just feel like I need to grip a little bit more for that support that, like, is a long isometric exercise and hold and that can create a lot of soreness when you’re now adding activity on top of that. So just being able to, like, do some down training exercises, being able to like, let go of some of that tension after your workout, before your workout, in part of your warm up or whatever cool down, that can make a big difference for managing some of that soreness, both, like proactively and, you know, in and reactively. But I find like, what a lot of athletes, who, who Matt, who like, have that symptom, are, tend to be doing,

Mindy English  22:59

yeah, in Group B, it’s a strategy, right? Like, holding something tight is a stability strategy. It doesn’t always mean it’s a good strategy. And again, it’s, like you said, I think it’s, yes, there’s things you can do to mitigate that while, either before or after, but I think it’s also worth doing that exploration of why, like, why is that the strategy My body’s using and what’s missing? Because, like, short term, we can kind of work through that, but long term, it’s probably going to start becoming a little bit more problematic for you.

Brianna Battles  23:29

Yeah, all right, postpartum prolapse, what different severities mean for different exercises. So maybe you mentioned what the different severities are for those who may not understand the scale of prolapse?

Mindy English  23:43

Yeah, so prolapse is graded. It’s graded on a scale. So it basically looks at how far down the vaginal canal something is descending as far as like grade of prolapse and exercise. What’s interesting about grade of prolapse is people can have what would be considered like a grade one prolapse, so not a lot of descent, and have a ton of symptoms, like they feel a ton of heaviness, it’s draggy, it feels uncomfortable. And you can have people who are lower, lower of a great so, you know, like a three, and so they’re, they’re kind of at the vaginal opening, coming out of the vaginal opening a little bit. And maybe, like you’re seeing something out of your you’re seeing something, yeah, and maybe not necessarily, they might feel some, I, I think most of those people feel some heaviness from my clinical experience, but it might not bother them, right? A whole lot. Like, there’s people who live with that and just choose not to do anything about it. That’s a different conversation. But so it’s hard to say it’s just like pain, right? You can’t say like. The degree of pain equals the amount of tissue damage there is just like the the grade of the prolapse doesn’t necessarily measure up to the amount of symptoms someone has. And what’s important to acknowledge, I think, for us, from a clinical standpoint, is if someone has symptoms, they have symptoms. And it’s not helpful to say, Oh, you don’t have that much of a prolapse, like you’re only a grade one, if that’s not something new for you, that feels really discouraging and like gaslighting, right? Like they still feel symptoms. And so especially

Brianna Battles  25:31

good athletes are so, like, aware of their body, and it like creates this, like, hyper fixation on their vagina,

Mindy English  25:39

yeah, yeah. And, and especially, like, if you’re newly postpartum this, maybe it’s like, your first time you’ve experienced this, and all of a sudden it feels like something’s falling out or pressure or like just doesn’t feel right with like sitting or lifting or whatever it is that’s feels scary, right? Like what just happened? I don’t know what this is. And so from an exercise choice perspective, I think it’s more it’s finding, again, when we go back to like, bracing and strategies, it’s finding strategies that help mitigate your symptoms as much as possible, finding exercises that feel most supportive to you. In general, something like a deep squat might feel kind of vulnerable with prolapse, if you’re not, if that’s new to you, and especially something with under a lot of load, okay, something where you have to lift even, even a deadlift, can feel kind of vulnerable if you’re not bracing well, and you’re trying to, like, lift, embrace something really heavy off the floor, like

Brianna Battles  26:50

you’re thinking about that, like a deep squat or like a deadlift, like that’s putting your pelvic floor in a maximally like lengthened position on the bottom, maximally lengthened when you’re bent over about to deadlift. Pelvic Floor is maximally, maximally lengthened, and that can feel scary when you feel like you’re something is coming out or like pushing downward.

Mindy English  27:09

And so if those are things that you enjoy doing, then it’s having a conversation about modifying those things. Can we modify depth? Can we change the variation of a deadlift where it doesn’t feel quite so vulnerable? Can we lift the weight up a little bit? Can we elevate the weight and that doesn’t feel quite so vulnerable? Can we decrease the weight? There’s lots of ways we can modify it. Doesn’t mean it has to be a no, don’t do it. But there’s probably some like, steps to get back to what you want to do first to make sure you feel really supported. So I don’t think there’s specific extra like, I don’t give like, this is my list of exercises for a grade one prolapse, and this is what I get for a grade two prolapse. I think it’s more it’s again, that whole clinical picture. What what do they feel? What movements do they feel that in? And how can we modify those movements so that it feels supportive,

Brianna Battles  28:06

right? It’s not always just like what exercise. It’s like how it’s being performed and and then manipulating all those training variables around it. And we try to stay away from the like, this is good, this is bad, like, that’s just movement and athleticism is so nuanced and so individual.

Brianna Battles  28:23

Okay,

Brianna Battles  28:25

is it normal that, after three pregnancies, whenever I’m on my period, it feels like I’m being kicked in the crotch, like a deep, aching pain that would feel really good with counter pressure, but there’s nowhere to actually push on. Don’t you love this stuff? Like, this is the stuff that is like, so, like, how Who do you even ask that to aside? For me, it’s great. I just love it.

Mindy English  28:44

Yeah. So not uncommon to feel pelvic floor symptoms when you’re on your period. So that can look like leakage. It could look like heaviness. Some people will feel almost it’s like cramping in the pelvic floor area. I have not assessed this pelvic floor. I will say anecdotally, those are people who probably carry a little bit of tension in the pelvic floor, or a lot of tension and then changes in hormones. You’re on your cycle like that’s how your body is reacting those muscles are planting and cramping a little bit again. Some down training can be great during that time, or even, like pre right, if you know a couple days before that it’s coming, you could start doing some down training, or try some down training type exercises before to try and mitigate it. Yeah, and even during right, if you can, again, lengthen yourself, feels good to get into a deep squat. You can hang out in a deep squat and kind of try and mitigate some of that pressure, that idea of needing a counter pressure. I mean, sometimes, again, there could be. Just a slight imbalance with muscles around the pelvis, or pelvis needs to move symmetrically. It also needs to move asymmetrically, and sometimes, when there’s something a little bit off, it can exacerbate some of that tightness and feeling that you feel.

Brianna Battles  30:13

Yeah, great question and good answer. How can you gage pelvic floor strength after you’ve been cleared to run, and have been consistently running twice a week and lifting with pelvic floor activation before exercises. I have been trying to run back to back days, but the first time I tried, I had leakage, but have incorporated more focused pelvic floor exercises and tried again, and then I was fine. I’d like to start running back to back days and for longer, but I want to be smart about

Mindy English  30:42

it, so I think this goes back to the idea of it’s not always just the pelvic floor. So pelvic floor is important. Pelvic floor is often what I would call the noisy victim, especially as we’re getting back into something like running or jumping, that’s going to require a little bit more endurance. So it’s not always necessarily strength. Sometimes it’s endurance of the pelvic floor. Oftentimes it’s strength and endurance of all the muscles around and so while it’s great, and again, I think postpartum, there is a need for a lot of women to be doing some pelvic floor strengthening. Like, I think we can’t just, like, brush that under the rug and get on the like, no Kegels train. Like there is a time and a place to be reactivating those muscles, reconnecting to those muscles, but when we’re getting back into our athletic endeavors. So first, I always recommend, like, a return to run screen. I’m going to shout out Carrie Pagliano, her return to run screen is awesome. It’s quick. I use it in the clinic all the time, and it’s a really nice way to identify where someone’s at, where they’re where there’s some we do like flags, right? So, red flag, yellow flag, green flag where there’s some deficiencies and basic muscles and movements that we need to be able to do well, to be able to run, to kind of figure out where that no pun intended, leak in the system is. And so if you haven’t done something like that, I’d really recommend it. If you’re trying to get back to running and you haven’t and you’re having problems also sometimes too. If we think about like, return to sport, return to play sometimes, and I think about this in our professional athletes too, if you take, I’m gonna say, like a baseball player, back through a return to play progression, they don’t always get to throw back to back, right in the early phases of return to play, like a lot of return to play programs, return to sport programs are kind of slow, like every other day, we take a rest day in between. And I think we have to acknowledge that in the postpartum space that sometimes we just need more time. And while the ultimate goal might be to get to back to back, that might not be where we’re at, yeah, we have to kind of honor our tissue healing. We have to honor where our body is at, and honor if I need, if I need to run, if I need to do activity for my mental health, what is my alternative on my rest day?

Brianna Battles  33:17

Yeah, yeah. There’s lots of great alternatives for that. And just like that, phase progression, progressive overload is is accepted in so many other realms of sport performance and clinical practice, and we have such like, great understanding and respect and trust of that process and postpartum we like just we don’t like, we truly assume, like I should be able to do what I was doing before, because I want to, because I I feel like I should be able to. But your body has been through a significant transformation for over a year. Like, well over a year, it is fundamentally different. Your lifestyle is fundamentally different. So building that capacity, and I call it like athletic readiness. Like, you have to have that phased progression to feel like it’s progressing in a way that’s not that’s like, mitigating as many setbacks as possible. Like, it’s not to say that there won’t be setbacks. It’s just like, how can we, like, extend that timeline so that it is relatively like, seamless, you know, and some of the athletes I’ve worked with, they’re good, good, good, and then they really turn up intensity, like, maybe they’re, like, getting ready for a competition. And now symptoms have spiked because, I mean, it’s a whole they’re they’re creating a more demand, more intensity, more load, whatever it might be. And now we have to, like, pull back a little bit, reassess, build that capacity and readiness and then keep building upon it like that’s all a normal part of it, and we understand that in other orthopedic circles, but we dismiss it a lot postpartum, and that’s that is a very common experience. And it’s not you’re doing anything wrong. It’s just that’s our

Mindy English  34:57

culture. Yeah, our culture is bounced. Zack, you’re you’re cleared to run. That should go no problem, right? Yeah,

Brianna Battles  35:04

you’ll find like your brain feel dirty, but your body just isn’t always Okay. Next question, instead of rib flare, I have a rib cage that sinks inward. Could it be a sign of rib gripping my pelvic floor? Physical therapist is confused, at least that’s what I think this means it’s like,

Mindy English  35:22

like, confused emoji, yeah, so the ribs are interesting. So, yes, you can have we, we talk a lot about rib cage flare. I think that’s where a lot of people live. Is kind of that, yeah, enlarged rib cage

Brianna Battles  35:41

are very extension based. App, like most of the time, a lot of our movement patterns are very extension rib cage thrusty athletes lifting, especially too, yes.

Mindy English  35:52

Now there are also a percentage of people who grip a lot and they really pull the rib cage in. I see it sometime in dancers, or former dancers, where runners, yeah, like it’s again, it’s a stability, it’s a strategy to try and get some support around your midline. And so, yes, oftentimes there is an imbalance that’s happening in your abdominal muscles and how you’re using them to support so, again, different things are going to work for different people. You know, sometimes, from a physical therapy standpoint, there is, like, some manual release that needs to happen, just like any other muscle, to kind of open that up a little bit. Sometimes it’s just cueing people to breathe differently, giving some tactile feedback, trying different positions, to try and be able to expand your rib cage a little bit more. I think with all things, it’s it’s being willing like so from a physical therapy perspective, we have to think about what muscles do that those actions. How can I get the opposite action to happen? What muscles are attaching to the rib cage? You know, all those things, all those things have to, like, go through my brain of why, why? What anatomically is happening there. And then we have to go into a strategy, because so you can release all you want. And if someone’s strategy is still to just over grip. They’re just going to go right back to it. And so the more important piece is, how can I cue someone out of this? How can I teach them a different strategy and help them understand what that feels like and why that might

37:33

be better for them? Yeah,

Brianna Battles  37:36

similar question. Can pelvic floor issues cause TfL and hamstring tightness, yes.

Mindy English  37:45

So, I mean, if you think again, if lots of muscles attach to the pelvis, and so, I will say, in general, a lot of pelvic floor, gripping, tucking under the glutes. Both those things put the pelvis in more of a like, posterior tilted position. It can jam a lot on the front of the hip when you do that, which can cause the TFL to be active a lot, and then you just get, like, this hamstring imbalance, right? So now, so now my hamstrings aren’t at their perfect tension length ratio, and so they’re having to work differently. And so the fun part for me is, this is a very it’s like layers of the onion, right? Like we don’t know how many layers we have to unravel sometimes when you start working with someone. So what I love about this question is, yes, yes, it can. And also, how do we figure? We have to figure out which one is driving all of it, yeah. And again, the why and how long has this been going on? Because if this has been going on for years, it’s not always as easy as like, let’s just do this one stretch or one exercise, and it’s going to be better because, again, there’s layers, there’s layers of compensation that your brain has figured out how to help you move your body in a way that feels successful for whatever you’re trying to do that we now have To undo a little bit to figure out. Like, why and how can we get you moving better?

Brianna Battles  39:25

Okay,

Brianna Battles  39:27

if you only had enough time and energy for three minutes, what is the best exercise to do for

Mindy English  39:32

the pelvic floor? Oh, that’s a tough question. Yeah, it depends. I think it depends on what your pelvic floor

Brianna Battles  39:40

means, screwing and what it needs. Yeah, I like for athletes anyway, who oftentimes have, like, high tension pelvic floor is what I refer to, not clinically in my coach brain, as the face down, ass up, where you’re just like on all fours. Can be on your forearms, head down. So that your butt is up in the air, and you can just sort of like, breathe into your glutes to help get that expansion and lengthening of the pelvic floor, and then exhale and like, kind of think about, like gently zipping, zipping the clit, so that I just thought I would lead, but like the really inappropriate version, and now you can do, like the nice version.

Mindy English  40:15

Yes, I love the inappropriate versions. Yeah. I think in general, like, I love cat cow for a lot of different symptoms and people, I think in general, like, a hands and knees position is a great way to connect with the pelvic floor. And there’s lots of variations that you can do. So if you, yeah, if you feel like you need to, like, open and lengthen, you can put yourself in, if we go in yoga terms, you can put yourself into, like a child’s pose, or a down dog, or, you know, those kind of positions to kind of lengthen and like you were saying, and kind of feel that the cat cow is nice because it’s just a nice way to kind of Connect rib cage with the pelvis, and tease out tension that you feel in other places, and kind of start connecting your breath there. And you can kind of vary your range of motion there. You can waggle your tail a little bit to just kind of see where, where you feel different things. So I think, from like an awareness standpoint, those kind of positions, right? So, like, you said, like, head down, bottom up, or, like, all fours, position is really nice. Are really nice positions just to connect,

Brianna Battles  41:31

yeah, helps the brain. Just helps your brain feel and, like, just, I don’t know, like, create, have a little bit more of that awareness. Okay, what can I do during pregnancy to help avoid issues down the line?

Mindy English  41:46

I love one of my favorite questions. I mean, so in pregnancy, so we know that there’s no guarantee, so you can do all the things in pregnancy, and there is no guarantee that there’s not problems down the line. And this is where, I think, you know, we’ve had lots of research this year come out about, like, exercise intensity during pregnancy, and that’s, it’s great. Like, love to see it. I think what’s going to be interesting, and what we don’t know is, what does it look like for people down the road, and can we even make a correlation? I don’t even know that we can make a correlation, because there’s so many variables that go into whether or not someone has pelvic floor symptoms, right? Like, your birth experience matters, your genetics matter. The size of your baby matters. All of those things matter. So I think the thing you can do during pregnancy is move as much as possible to feel good, like, feel good during your pregnancy, find ways to move your body that feel good during your pregnancy. That’s the best thing you can do. Like, there’s not, there’s not a magic formula. There’s, I mean, I have people all the time who they’ve done. We did all the pelvic floor rehab, we did all the birth prep, and their birth still just didn’t go well, right? Like there’s

Brianna Battles  43:06

just so many variables you can’t control. And I think athletes, they want that. They want to feel like I’m prepared. I am doing everything I can to sort of dictate a very specific outcome, mentally, physically, emotionally, and that’s great, like feeling informed, aware all of that is great. And we just, we don’t have that level of control. We just vote. And for all the variables you mentioned, one way to reframe this though, that I like to use with athletes, pregnant athletes in particular, is exercise is one of the variables you actually can’t control. And it’s not just like exercise selection, it’s like overall exercise approach. It’s not a time to, like, I feel like you don’t have anything to prove to yourself or others, like you’re still going to be very fit and strong just by, like, maintaining an exercise routine. And that’s all beneficial. Exercise is a benefit. It’s just not a guarantee of anything. But your approach is one of the variables out of this whole picture that you actually do have control of. So what we look at like, Is this safe? How much can I do? What can I not do? What’s this saying? What’s that saying? There’s a lot of noise. There’s so much noise and it makes it confusing. But if you can zoom out and say, like, what is something that I actually do have control of? It’s how I approach my training, mentally, physically, emotionally, spiritually during this season and like, that’s the whole approach that I feel gives you the most guarantee of a positive outcome, because you have, you have sort of surrendered to the process of like I’m actually not trying to control all of these other variables. I’m doing what I can to feel good. I’m doing what I can to be aware of my body and its changes in the different predispositions I may have when it comes to core and pelvic floor. And then it’s going to set you up for an informed postpartum recovery, regardless of. What your birth method is, because you’re like, all right, I know what to do if I prolapse, I know what to do if I have incontinence, I know what to do if I have a diastasis, I know what to do. Like, done that proactively during

Mindy English  45:10

pregnancy. And I think, you know, I think the thing I’ve been thinking about a lot lately with, like, combining the research that’s coming out and that idea of like, I agree. I don’t think we have to prove anything during pregnancy. D load doesn’t mean deconditioning, adapting and modifying doesn’t mean weakness. It doesn’t mean deconditioning. Doesn’t mean that you should be doing more. It means you’re supporting your body and supporting changes in your body, and it’s a normal part of strength and conditioning programming. It’s a normal, it’s a normal, normal

Brianna Battles  45:45

part of a lifetime of athleticism like this. This is a lifetime. There’s no freaking timeline on

Brianna Battles  45:51

this. Yeah, yeah. I talk girl. I’ve man, you know, yeah, yeah. Similarly.

Brianna Battles  46:01

Is it worth getting evaluated while pregnant, or should I just wait till after birth?

Mindy English  46:08

Yeah, I think if you have access and ability to get evaluated during pregnancy, I think it’s helpful. It tells us so it doesn’t give us like a full baseline, because you’re already pregnant. So I don’t know what your like, pre base line was, pre pregnancy baseline was, but it at least allows you to understand already what your tendencies are, because you can, you can already identify during your pregnancy. Do I tend to hold tension? Do I you know, what does that look like? What breathing? How do I like to move? Do I bear down all those things? So I think the people that I work with, that I worked with during pregnancy and postpartum, it just, it gives a reference point postpartum, and I think that’s really helpful, is like, Well, remember when we, like, did this during pregnancy, like, you had a really hard time relaxing, we’ll say, and now, like, that seems like you’re doing a pretty good job with that, right? So they can kind of remember, like, oh yeah, like I did, used to hold a lot of tension. It also tells us there could be a tendency down the road that they’re going to create some tension again. So I think it just, it’s a nice it’s a nice reference point. It’s nice to know where you’re at. And I think a lot of people think they know how to relax their pelvic floor, and they don’t. And so I think just meeting with someone to get evaluated and understand, do I understand what it means to let go of that tension in the pelvic floor, and really find that true, like, end range of motion of my pelvic floor, so that when I am laboring, assuming that I’m attempting to have a vaginal birth, that I am not fighting, fighting that and gripping my pelvic floor, thinking that I’m relaxing. And I think a lot of women do that. A lot of women think they’re relaxed and they’re kind of like at this like, I use an elevator a lot, so it’s like, a level one tension, right? You’re like, on the first floor of tension. I need you to get to the basement. But if you think level one tension is relaxed, like, because you didn’t know or weren’t assessed, you don’t, you just don’t know. You only know you don’t know what you don’t know, right? So if I don’t know that, there’s a whole nother level that I’m missing, then I don’t realize that

Brianna Battles  48:24

I’m not right. And it’s like, not intuitive. Like, at least it wasn’t for me. And I think back when I was, like, in labor with Cade 12 years ago. Like, I remember, like I was racing into Jared so freaking hard, like, grinding my teeth and like, I can just imagine, like, the subconscious pelvic floor contraction I was holding because it was just like, you’re like, bearing, you’re just gripping and like, it’s so much tension being held, instead of like, relaxing. And relaxing is not where my brain goes under stress. My brain goes to like, Max contraction. And I think that’s really normal for athletes, unless you have created that familiarity of like, what it feels like to let go of tension and to not contract through pain or not like, have that be your main strategy. And again, it’s just not intuitive

Brianna Battles  49:18

always. Yeah,

Brianna Battles  49:20

I know that we need to wrap up because you have clients to get to, or patients I

Mindy English  49:26

got a shower and not look like I just got done at the gym.

Brianna Battles  49:29

So we got

Brianna Battles  49:31

through, I’d say, 85% of our questions, which was great. And I think that we can incorporate this into an ongoing part of our pelvic floor series, words, we just poll audience questions. If we didn’t get to your question. If you have additional questions after listening to this episode, please feel free to you can either email Hello at Brianna battles.com or you can DM Mindy personally. You can DM the brand page, and we will, we’ll try to get those questions answered. Or whether it’s on a podcast or through a social media post or one on one response, we are here to help and create a little bit more like, just like candid conversations around this at a high level, but also making it digestible and practical for anybody listening. So Mindy. Thank you so much for sharing and coming on. And it was great. Yeah,

Mindy English  50:17

thanks for having me. Absolutely.

Brianna Battles  50:24

thank you so much for listening to this episode of the Practice Brave Podcast. If you enjoyed the show, please leave a review and help us spread the work we are doing to improve the overall information and messaging in the fitness industry and beyond. Now, if you are pregnant and you are looking for a trustworthy exercise program to follow. I have you covered. The pregnant athlete training program is a well rounded program for pregnancy with workouts for each week that are appropriate for your changing body. That’s 36 weeks of workouts, three to four workouts each week, and tons of guidance on exercise strategy. We also have an at home version of that program if you are postpartum and you’re looking for an exercise program to follow. The eight week postpartum athlete training program would be a really great way to help bridge the gap between rehab and the fitness you actually want to do. From there, we have the Practice Brave fitness program, which is an ongoing strength conditioning program, where you get new workouts each week and have a lot of guidance for myself and my co coach, Heather Osby, this is the only way that I’m really offering ongoing coaching at this point in time. If you have ever considered becoming a certified Pregnancy and Postpartum Athleticism coach, I would love to have you join us. Pregnancy and Postpartum Athleticism is a self paced online certification course that will up level your coaching skills and help connect the dots between pelvic health and long term athletic performance, especially during pregnancy and postpartum, become who you needed and become who your online and local community needs by becoming a certified Pregnancy and Postpartum Athleticism Coach, thank you again for listening to the practice brave podcast. I appreciate you, and please help me continue spreading this messaging, this information and this work.